The availability of high-quality evidence to recommend treatment strategies for Chronic Pain Disorders is limited (World Health Organisation, 2008). Therefore, treatment should be focussed on the best option for the individual using clinical judgement.
Treatment or Management Plan
Following assessment and evaluation of your chronic pain condition, a treatment or management plan should be formed between you and your healthcare professional with your input, understanding and agreement. This should include all information necessary to help you regain control and management of your pain.
Some of this goes back to the importance of health literacy and knowledge of your condition and treatments that you are undertaking.
Plans make include taking pain medication, additional procedures, exercise, psychological therapy etc and should also focus on interventions and goals that help you to maintain or improve functional ability. Use self-management techniques and strategies and build what works for you into your own management plan.
There are several types of pain medication that can be effective in helping you to manage your pain including simple analgesics e.g. paracetamol, NSAIDS (non-steroidal anti-inflammatory drugs (NSAIDs), and/or stronger analgesics such as opioids and perhaps adjuvant medications (antidepressants or anticonvulsants) which would not usually be considered an analgesic but which have been found to be effective in treating chronic pain. In 2021 EFIC published a position paper on the use of opioids for non-cancer pain see here and PAE published an information leaftlet for patients here
Exercise & Physical therapy
There are many treatments that can help for example heat/cold therapy, peripheral nerve stimulation / transdermal electronic nerve stimulation (TENS), occupational therapy, therapeutic exercises for example hydrotherapy can restore joint movement while strengthening and conditioning muscles, exercise programmes and physiotherapy. Exercise is important and if you are not able to do a lot, then maybe start small and set a realistic goal. Find something that you enjoy doing and discuss with your healthcare professional. For more details on the benefits of physiotherapy, exercise therapy and personalised programs goto http://www.chronicpain.ie/document-bank/physiotherapy-chronic-pain
In addition to medication your pain consultant may discuss some interventional procedures that may be effective in treating your pain these can include intramuscular or joint injections, peripheral nerve blocks, regional blocks or sympathetic blocks.
Advanced Interventions include neuromodulation, intrathecal pump and vertebroplasty.
Psychological therapies can help people to cope with pain, depression and disability that can occur. It focuses on acknowledging your pain, stress management, dealing with guilt, identification of negative factors and importance of positive thinking, identification of goals and looking at supports including relaxation therapies, challenging negative or unhelpful beliefs/thoughts
Self-Management fits well with clinical approaches and the sooner you start the better. It's not easy but it is possible. A lot of people make huge improvements in the quality of their life when they thought all was lost. While there is no immediate cure for Chronic Pain implementing strategies/techniques through self-management can help reduce your pain, improve the quality of your life and puts you, not the pain, in control.
Self Management is an approach to improving health and well-being by addressing the impact chronic pain has on life i.e. stress, anxiety, poor sleep and over-doing things. It is important to take control wherever possible through improving understanding and building skills in relaxation, stress management, pacing and challenging negative thinking.
Pain Management Programme
A Pain Management Program (PMP) is a psychologically-based rehabilitative treatment for people with persistent pain. It is delivered in a group setting by an interdisciplinary team of experienced health care professionals working closely with patients. Some Pain Centres may run Pain Management Programs that aim to teach a group of patients with similar problems about pain, how best to cope with it and how to live a more active life.
For the majority of people, attending a Pain Management Program reduces the disability and distress caused by persistent pain by teaching physical, psychological and practical techniques to improve quality of life. It differs from other treatments provided in Pain Clinics in that pain relief is not the primary goal, although improvements in pain following participation in a Pain Management Program have been demonstrated.
Referral to a Pain Management Programme is usually through your general practitioner to your local pain clinic.
There are public pain management programmes in:
- St Vincent’s University Hospital, Dublin
- Tallaght University Hospital, Dublin
- The Mater Misericordiae University Hospital, Dublin
- Mercy University Hospital, Cork
In addition, St James Hospital, Dublin offer mindfulness meditation.
Online self-management strategies course
In Galway, NUIG's Centre of Pain Research have developed an online course which shares evidence based information about chronic pain and self-management strategies that can help. Divided into three main sections, the entire course will take about 45 minutes and will list further reading and online resources. This a very useful online resource and To access click here
The HSE has rolled out the Living Well with Chronic Illness programme in 2020 and while not specifically tailored for those living with chronic pain, it is aimed at any person living with a chronic illness. This free programme is very useful in learning new coping strategies. Details can be found here